32 West Main Street #5
Waynesboro, PA 17268
Office: 717-749-5767 (Call Office number first!)
Gmail phone: 717-925-0585

Forms and Instructions

NEW: Diploma Program Participants:Login
Members of MDHSA Local Support Group:Login

The MDHSA Office will be closed for Thanksgiving / Fall break from 11/18/17 through 11/27/17.  If you have any questions or concerns during this time, please email the office.

Please read the MDHSA Diploma Guide for complete information and instructions on registering with the Program, as well as using the Diploma Program Forms.  (Newest Diploma Guide version is Spring 2016)

DIPLOMA PROGRAM FORMS  

Yearly Checklist

Use this form to help ensure that you have all of your paperwork and documentation in order.  For personal use only.  Please do NOT send this form to the MDHSA office.  Click here for special notes regarding filing instructions.

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Registration/Annual Filing Form (RF)

FAMILIES MUST PURCHASE AN MDHSA DIPLOMA GUIDE BEFORE REGISTERING WITH THE PROGRAM!

**NEW** Online Diploma Program Registration form now available.  Please visit the Purchase page to register online.

Use the Registration / Annual Filing Form to register with the MDHSA Diploma Program;  please submit this form EACH TIME yearly paperwork is submitted to the MDHSA office.

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Annual Summary and Transcript (ASF and TX) 

IMPORTANT CHANGES TO THE ASF/TX:  This document will no longer be accessible via this page of the website.   The form is ONLY accessible to Diploma Program Evaluators and families registered in the MDHSA Diploma Program via a secured section of the website.   All DP Evaluators and registered families have been/will be sent instructions on how to access the new, secured area so they may obtain the ASF/TX.

NOTICE:  AN OFFICIAL TRANSCRIPT MUST BE SEEN BY, APPROVED BY, AND ISSUED FROM THE MDHSA OFFICE.  An official Transcript bears the MDHSA seal or stamp and Officer’s signature.  Printing a draft of the Transcript and distributing that document as an official transcript constitutes a fraudulent use of the MDHSA Diploma Program.   The MDHSA Transcript Form, used with or without the MDHSA name, may not be used for any purpose other than the MDHSA Diploma Program.  Using the MDHSA name or logo on any Transcript other than the provided MDHSA Transcript is prohibited.   In each case, appropriate legal action could be taken.

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Diploma Request Form (DR)

Send this form in when sending in the final paperwork after the 12th grade evaluation to request a diploma.

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Honors Applications

Limit of 3 per student.  Please see the Diploma Guide and the Honors Application for requirements.

Honors Include:

  • Academic Honors 
    • **NEW** Academic Honors – Important Information for Parents and Evaluators:  Please make sure any students graduating 2016 and beyond are following and submitting to MDHSA the current Academic Honors Application that is on the MDHSA website.There are specific courses, etc., that must be met before even applying for the honor.  However, once that requirement has been met, the awarding of the honor is based on other criteria which are listed at the bottom of the form in the rubric for the staff to use as a guideline.  Please remind your parents to look at the rubric at the beginning of the 9th grade and review it each year.The academic honors diploma is the most time consuming diploma to award. We do not simply churn these out since we want our honor to have meaning.Thank you for your help. If you have any questions, please email us at diploma@pa.net.
  • Diploma with Distinction for Leadership or Service
  • Diploma with Distinction for Academic Achievement
  • Performance in Fine Arts 
    • Performance in Fine Arts: Music – Checklist of concepts required for the Music Honors
  • Vocational Honors

These forms are to be used by students applying for an honor on their diploma.  Honors Applications and associated documentation should be submitted with the Diploma Request Form.

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Transcript Request Form (TR)

NOTICE:  AN OFFICIAL TRANSCRIPT MUST BE SEEN BY, APPROVED BY, AND ISSUED FROM THE MDHSA OFFICE.  An official Transcript bears the MDHSA seal or stamp and Officer’s signature.  Printing a draft of the Transcript and distributing that document as an official transcript constitutes a fraudulent use of the MDHSA Diploma Program.  The MDHSA Transcript Form, used with or without the MDHSA name, may not be used for any purpose other than the MDHSA Diploma Program.  Using the MDHSA name or logo on any Transcript other than the provided MDHSA Transcript is prohibited.   In each case, appropriate legal action could be taken.

Online or PDF  Transcript Request Forms  available.  See below for details.

Fee:  Transcripts are $5.00 each. Please allow up to 2 weeks to process a Transcript Request.  If the request must be processed in 7 business days or less (excluding office closures and holidays), an ADDITIONAL $15.00 RUSH fee must be added to the total cost of the Transcripts.  (For RUSH orders, please pay the original Transcript fee PLUS the $15.00 RUSH fee.)

Online Form:  Use this form when requesting an official Transcript be mailed to a college, university, employer, or other institution.  PayPal or credit card is accepted for this method.  Please note:  ALL PAGES of the online form MUST be completed in order for a Transcript Request to be processed.

PDF Forms:  Print a PDF  copy of the one-page Transcript Request Form and mail it to the MDHSA office.  Check or Money Order is the accepted form of payment for this ordering method.

NOTICE:  The MDHSA Office cannot fill Transcript Requests made by 3rd parties (i.e. employers or facilities requesting education verification).  All Transcript Requests must be made by the student / family.  Any other party requesting a Transcript will have their order cancelled.  For education verification, please email diploma@pa.net.

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 How to Calculate GPA 

Use this form when calculating the GPA.  MDHSA does not calculate GPA for students.

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Public/Private School Review (PSR)

This form is only necessary if you prefer that MDHSA review a public school transcript before meeting with an evaluator.  A PSR form submitted to the MDHSA office will be used to verify what courses are accepted and what courses still have to be taken in order to graduate with an MDHSA diploma.  NOTE:  If the Evaluator is doing this service for the student, do not submit the form to the MDHSA office.

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Application for Prior Credits (PC)

Use this form to request credit for up to two courses from 7th or 8th grades.

PLEASE NOTE:  In order to receive credit for high school, there must be a demonstration of mastery of the subject at the high school level.  Just because a student participates in a secondary level course and “completes” the assignments does not necessarily qualify the student to receive high school credit towards graduation. The work must demonstrate that the student has made the leap from the concrete, linear thinking typical of elementary students to abstract, complex thinking that is more that of adults or adolescents.  PLEASE READ THE “APPLICATION FOR CREDITS EARNED PRIOR TO NINTH GRADE” section in the MDHSA Diploma Guide.

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Confirmation of Receipt of Mailed Paperwork

Please do not send mail or Fed Ex that requires a signature for delivery (this includes CERTIFIED MAIL)!

Since the office is staffed part time, the USPS / FedEx delivery notice may not be seen by the staff until after 
the item has already been returned to the sender!  If you desire to have confirmation that paperwork has been 
received by the MDHSA office, please include an unsealed self addressed stamped envelope with the documentation, 
along with the "CONFIRMATION OF RECEIPT OF MAILED PAPERWORK" form.  Upon receipt of the paperwork, the MDHSA office 
staff will verify the items on the form and return it to you in the SASE that you provided!

If you cannot access any of the above PDF files, contact diploma@pa.net.

PHEAA GRANT APPLICATION INSTRUCTIONS:

An updated application process, homeschooler friendly, and specific to the supervisor (parent) issued diploma is available here.  For more information, please visit https://phea.net/


MDHSA does not discriminate against families on the basis of race, color, national or ethnic origin.

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